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. 2025 Jul 30;145(1):389.
doi: 10.1007/s00402-025-06005-5.

Total wrist arthroplasty revisited: survival, function, and patient-reported outcomes of BIAX and universal II prostheses over 15 years

Leonhard Mandl  1   2 , Alfred Gruber  2 , Raymund E Horch  1 , Resit Demir  3   4
Affiliations

Total wrist arthroplasty revisited: survival, function, and patient-reported outcomes of BIAX and universal II prostheses over 15 years

Leonhard Mandl et al. Arch Orthop Trauma Surg. .

Abstract

Background: In the management of degenerative osteoarthritis and rheumatoid arthritis of the wrist, surgical intervention remains an important treatment option when conservative approaches such as medication, physiotherapy, and assistive devices prove insufficient. Despite decades of development, no single wrist prosthesis has yet emerged as the definitive standard in total wrist arthroplasty. To address this gap, the German Society for Hand Surgery established the Total Endoprosthesis (TEP) Register in 2004 to systematically collect and evaluate long-term clinical outcomes. The present prospective single-centre study analyses and presents the long-term results of patients enrolled in the TEP register, offering valuable insights into the performance and durability of wrist prostheses in a real-world clinical setting.

Patients/materials/methods: Between 2000 and 2011, a total of 29 total endoprostheses were implanted in 25 patients in a single centre study due to severe degenerative changes in the wrist. Of these, 22 had rheumatoid arthritis and 3 degenerative osteoarthritis. The prosthesis models BIAX (N = 13) and Universal II (N = 16) were implanted. The present study describes the mean outcome after a mean observation period of 13.8 (1.7-21.4) years for the BIAX prosthesis and 10.5 years (0.2-16.4) for the Universal II prosthesis.

Results: The probability of survival after 15 years is 60% for the BIAX prosthesis and 41% for the Universal II prosthesis. After 21 years, results are only available for the BIAX prosthesis with a value of 60%. The BIAX prosthesis showed a lower complication rate. Subjectively, 15 years postoperatively, the BIAX prosthesis showed a lower mean value in the QuickDASH score (BIAX 33.8%, Universal II 50.3%), lower results in the visual analogue pain scale under stress (BIAX: 1 point; Universal II: 3 points) with higher patient satisfaction (BIAX: 86%; Universal II: 78%).

Conclusion: In conclusion, our observations show that the BIAX prosthesis is superior to the Universal II prosthesis 15 years after surgery in terms of survival probability, complication rate and better results in satisfaction, the visual analogue pain scale and the QuickDASH score.

Keywords: BIAX; Total Wrist Arthroplasty; Universal II.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Survival time of the BIAX and universal II prosthesis
Fig. 2
Fig. 2
Case 1 - Left preoperative X-ray in lateral and a.p. view
Fig. 3
Fig. 3
Case 1 - Left postoperative X-ray in lateral and a.p. view
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Fig. 4
Case 2 - Left preoperative X-ray in lateral and a.p. view
Fig. 5
Fig. 5
Case 2- Left postoperative X ray in lateral and a.p. view
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Fig. 6
Case 3– Right preoperative X-ray a.p. view
Fig. 7
Fig. 7
Case 3– Right postoperative X-ray in lateral and a.p. view. Twenty-one months after implantation of a BIAX-prosthesis
Fig. 8
Fig. 8
Case 3– Postoperative X-ray of the right wrist (lateral and a.p. view) 16.4 years after revision surgery, replacing the BIAX prosthesis with a Universal II prosthesis
Fig. 9
Fig. 9
Case 4– Right preoperative X-ray in lateral and a.p. view
Fig. 10
Fig. 10
Case 4– Right postoperative X-ray in lateral and a.p. view
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References

    1. Halim A, Weiss AP (2017) Total wrist arthroplasty. J Hand Surg Am 42:198–209 - PubMed
    1. Wei Q, Liu C, Chen S, Liu M (2025) Customized metal 3D printed total wrist prosthesis in the treatment of severely destroyed wrist: design rationale and clinical applications. Orthop Surg 17(5):1536–1546 - PMC - PubMed
    1. Sivakumar B, Rapisarda A, Freeman H, Xu J, Graham D (2025) Metal-on-metal disease in wrist arthroplasty: a systematic review and proposed management algorithm. Eur J Orthop Surg Traumatol 35(1):126 - PubMed
    1. Krukhaug Y et al (2011) Results of 189 wrist replacements. A report from the Norwegian arthroplasty register. Acta Orthop 82:405–409 - PMC - PubMed
    1. Gendera H et al (2020) Medium term outcomes of the universal 2 total wrist arthroplasty in patients with degenerative or posttraumatic osteoarthritis of the wrist. Acta Orthop Belg 86(3):549–554 - PubMed

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